Sistemik Skleroz İlişkili İnterstisyel Akciğer Hastalığında Tedavi Yanıtını İzlemede Bilgisayarlı Tomografiye Dayalı Yeni Parametreler

Abstract

Yüksek çözünürlüklü bilgisayarlı tomografi (YÇBT) ve solunum fonksiyon testi (SFT) günümüzde Sistemik Skleroza bağlı interstisyel akciğer hastalığının (SSk-İAH) tanısında, tedavi kararında ve tedavinin takibinde kullanılan başlıca yöntemdir. Çalışmamızın amacı, YÇBT görüntülerini analiz ederek hastaların takibinde kullanılabilecek yeni kantitatif parametreleri araştırmaktır. Çalışmaya SSk-İAH nedeniyle tedavi gören, başlangıç ve 12.ay takipleri sırasında YÇBT ve SFT sonuçlarına ulaşılabilen 35 hasta dahil edildi. Hastaların YÇBT görüntüleri Vitrea® Advanced Visualization yazılımı ile analiz edildi. Akciğer atenuasyon eğrisi kullanılarak sağ ve sol akciğerler için ortalama akciğer atenuasyonu (OAA), düşük-, orta- ve yüksek-yoğunluklu akciğer hacimleri, düşük dansite (DD) indeksi ve yüzde dansite 15 (YD15) elde edildi. Elde edilen parametrelerin zaman içerisindeki değişimi ve SSk-İAH hastalarında tedaviye yanıtı değerlendirmek için kullanılan FVC ve DLCO testleri ile arasındaki ilişki incelendi. Çalışmadaki hastaların %82,9’u kadın, %63’ü diffüz cilt tutulumlu, hastalık süresi 8,13±5,96 yıl ve ortalama yaş 53,8±9,96’tı. Takip FVC, DLCO ve tüm BT parametrelerinde başlangıca göre bir değişim saptanmadı. Başlangıç ve takipte DLCO’nun BT parametrelerinden hiçbiri ile korelasyon göstermediği, ancak FVC’nin hem başlangıçta hem de takipte sağ/sol orta-yoğunluklu akciğer volümü ve sağ/sol total akciğer hacmi ile ilişkili olduğu saptandı. Ayrıca fibrozis skoru ile hem başlangıç hem de takipteki sağ ve sol akciğer ortalama atenuasyonu, orta dansiteli volüm, yüksek dansiteli volüm ve akciğer volümü ile orta-kuvvetli ilişki saptandı. Çalışmamızın sonucunda, SSk-İAH hastalarında hem başlangıç hem de takip FVC ve fibrozis skoru ile anlamlı korelasyon gösteren kantitatif YÇBT parametreleri saptanmıştır. Sonuçlarımız, SFT gibi hasta kooperasyonundan ve semi-kantitatif fibrozis yaygınlık skoru gibi radyologların değerlendirmesinden etkilenmeyen parametrelerin geliştirilmesine katkı sağlayacaktır.

Keywords

• sistemik skleroz
• interstisyel akciğer hastalığı
• yüksek çözünürlüklü bilgisayarlı tomografi

New Computed Tomography-Based Parameters for Monitoring Treatment Response in Systemic Sclerosis-Associated Interstitial Lung Disease

Abstract

High-resolution computed tomography (HRCT) and pulmonary function test are currently the main methods used in the diagnosis, treatment decision, and follow-up of systemic sclerosis-associated interstitial lung disease (SSc-ILD). We aimed to analyze new quantitative parameters that can be used in the follow-up of patients by analyzing HRCT images. 35 patients whose HRCT and PFT results were available at baseline and 12th-month follow-up were included in the study. HRCT images of the patients were analyzed with Vitrea® Advanced Visualization software. Using the lung attenuation curve, mean lung attenuation, low-, medium-, and high-density lung volumes, low-density index, and percent density 15 were obtained. Of the patients in the study, 82.9% were female, 63% had diffuse skin involvement, the disease duration was 8.13±5.96 years, and the mean age was 53.8±9.96 years. There was no change in follow-up FVC, DLCO, and CT parameters from baseline. DLCO did not correlate with any of the CT parameters at baseline and follow-up, but FVC was associated with right/left medium-density lung volume and right/left total lung volume at baseline and follow-up. In addition, a moderate-strong relationship was found between the fibrosis score and the mean attenuation, medium-density volume, high-density volume, and lung volume both at baseline and at follow-up. Quantitative HRCT parameters were found to be significantly correlated with both baseline and follow-up FVC and fibrosis scores in SSc-ILD patients. Our results will contribute to the development of quantitative parameters that are not affected by patient cooperation, or the evaluation of radiologists' experience.

Keywords

• systemic sclerosis
• interstitial lung disease
• high resolution computed tomography

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